<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="{$row.user_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Realname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-realname" data-rule="required" class="form-control" name="row[realname]" type="text" value="{$row.realname|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Phonetext')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phonetext" data-rule="required" class="form-control" name="row[phonetext]" type="text" value="{$row.phonetext|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Coupon_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-coupon_id" data-rule="required" disabled="disabled"  data-source="coupons/coupon/index" class="form-control selectpage" name="row[coupon_id]" type="text" data-field="id" value="{$row.coupon_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Appointmenttime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-appointmenttime" data-rule="required" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[appointmenttime]" type="text" value="{:$row.appointmenttime?datetime($row.appointmenttime):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Clinic_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-clinic_id" data-rule="required" disabled="disabled" data-source="coupons/clinic/index" class="form-control selectpage" name="row[clinic_id]" type="text" value="{$row.clinic_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Contenttext')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contenttext" data-rule="" class="form-control" name="row[contenttext]" type="text" value="{$row.contenttext|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Coupon_order_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-coupon_order_id" data-rule="required"  disabled="disabled"  data-source="coupons/order/index" class="form-control selectpage" name="row[coupon_order_id]" type="text" value="{$row.coupon_order_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Statuslist')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-statuslist" disabled="disabled" data-rule="required" class="form-control selectpicker" name="row[statuslist]">
                {foreach name="statuslistList" item="vo"}
                    <option value="{$key}" {in name="key" value="$row.statuslist"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>